MEDICARE: MOUNTAIN DENTAL P.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QD0000X	Dental Clinic/Center	DS0000004867	TN

General Provider Information

NPI Number	:	1225202898
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MOUNTAIN DENTAL P.C.

Provider Business Mailing Address
First Line	:	6215 RIVERVIEW CROSSING DR STE C
Second Line	:
City	:	KNOXVILLE
State	:	TN
Zip	:	37924-2839
Country	:	US
Telephone Number	:	865-546-7436
Fax Number	:	865-546-7259

Provider Business Practice Location Address
First Line	:	6215 RIVERVIEW CROSSING DR STE C
Second Line	:
City	:	KNOXVILLE
State	:	TN
Zip	:	37924-2839
Country	:	US
Telephone Number	:	865-546-7436
Fax Number	:	865-546-7259

Authorized Official
Title or Position	:	DENTIST
Name	:	MRS. CHARLES D FISHER
Credential	:	D.D.S.
Telephone Number	:	865-546-7436

Provider Enumeration Date	:	04/15/2008
Last Update Date	:	04/15/2008

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Directions to “MOUNTAIN DENTAL P.C. ” Practice Location

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